Journal of Pediatric Psychology最新文献

Objective: There is a need for a systematic review on social functioning and peer relationships among adolescents with chronic pain (ACP) given the high prevalence of chronic pain in adolescence and integral role of peer relationships in adolescent development. This review aims to examine the methods used to evaluate social functioning, the types and extent of peer relationship difficulties, and pain characteristics and sociodemographic factors related to social functioning in ACP.

Methods: A systematic literature search of PubMed, PsycINFO, CINAHL, Web of Science, and Cochrane databases was performed. Included studies were written in English, presented original, quantitative, peer-reviewed research, had a primary focus on social functioning or peer relationships in ACP, and included study participants between the ages of 10 and 18 years. The review was registered in PROSPERO (No. CRD42022364870).

Results: Twenty-eight articles were included in the review. All studies used self-, parent-, or peer-report questionnaires to evaluate social functioning. Most (89%) of the studies were cross-sectional. Findings suggest that ACP experience social difficulties frequently characterized by loneliness, social anxiety, withdrawal, and peer victimization. Studies examining the associations between social functioning and sociodemographic variables, pain location, and pain-related characteristics yielded mixed findings. Study quality was mixed, with 57.14% rated as "good."

Conclusions: Findings from this review emphasize the increased risk of reduced social connectedness and the complexity of underlying mechanisms associated with poorer social functioning among ACP. Additional research utilizing longitudinal methodologies is needed to understand potential moderators and directionality of associations between chronic pain and social functioning.

Objective: Adolescent emotion regulation (ER) has been positively linked to caregiver-adolescent sexual communication. With ER becoming increasingly conceptualized as an interpersonal process, it is likely that both adolescent and caregiver ER impact communication patterns to some extent; thus, each must be accounted for in scientific inquiry and intervention approaches. We aimed to identify distinct profiles of caregiver and adolescent ER and examine how each profile is differentially related to caregiver-adolescent communication about sexual health and relationships.

Methods: Participants included adolescent males (n = 117; Mage = 13.06; SD = 0.72) and their caregivers (Mage = 42.33; SD = 0.72) who were recruited as part of a dyadic, web-based dating violence prevention intervention trial for middle school boys.

Results: Using a self-report measure, three clusters were identified: families with Moderate ER strategy use (by both parents and adolescents), families with Low ER strategy use (by both parents and adolescents), and families with Mixed ER strategy use (moderate adolescent but low caregiver ER strategy use). Caregivers in the Moderate ER strategy use cluster reported discussing the greatest total number of sexual health and relationship topics. Adolescents in the Mixed ER strategy use cluster indicated the greatest perceived caregiver openness during discussions.

Conclusions: Findings suggest that adolescent ER may more strongly influence positive patterns of communication regarding sexual health and relationships than parent ER. Future research should compare the efficacy of adolescent sexual health and dating interventions with adolescents alone versus dyadic interventions to determine whether there is a clinically significant additive effect of including caregivers or if adolescent engagement alone may suffice.

Objective: Though diet is important in the management of many pediatric chronic medical conditions, the last comprehensive review of interventions targeting dietary adherence was published over 20 years ago. This systematic review provides an update on efficacy and existing gaps for dietary adherence interventions in pediatric disease management.

Method: We searched PubMed, MEDLINE, Embase, CENTRAL, PsychINFO, Web of Science, and Scopus up to July 1, 2023 for randomized controlled or clinical trials of interventions that targeted dietary adherence in youth 0-18 years old with a chronic medical condition (not obesity), included nutrition education and behavioral/psychological support, and reported dietary adherence outcomes. We identified manuscripts (N = 15) that spanned four broad diet types (healthy, carbohydrate-modified, elimination, single-nutrient modified), 10 pediatric chronic medical conditions, and 1,110 participants. Primary (dietary adherence) and secondary (disease metrics) outcome findings are organized by diet type; other descriptive information is collapsed across trials.

Results: Overall, interventions yielded moderate-high adherence for most diet types. Interventions used similar approaches for nutrition education (e.g., meal plans) and behavioral support (e.g., goal setting, monitoring, feedback). Risk of bias was assessed using the Quality Criteria Checklist for Primary Research (Academy of Nutrition and Dietetics Evidence Analysis Process) revealing bias may be present in five trials.

Conclusions: Interventions targeting dietary adherence remain sparse. Research is needed to examine adherence in all pediatric chronic conditions where diet is a component of disease management and to identify factors impacting dietary adherence and best practices for intervening on dietary adherence. This protocol is registered on April 5, 2024 at the Open Source Framework: https://doi.org/10.17605/OSF.IO/46YNF.

Objective: To perform a systematic review and meta-analysis of randomized controlled trials (RCTs) of behavioral interventions for sleep disruption in children with neurodevelopmental and medical conditions.

Methods: A comprehensive literature search was designed and run for studies published between 1970 and July 1, 2023. Original, peer-reviewed RCTs of children ages birth to 18 years with/at risk for sleep disruption and a neurodevelopmental and/or medical condition were included. Interventions without behavioral components, lifestyle interventions, or pharmaceutical interventions were excluded. Primary outcomes included sleep health domains, and secondary outcomes were condition symptomatology and quality of life.

Results: Data from 15 RCTs were examined (1,374 participants, 78% male, 71% White). Sleep disruptions were predominantly insomnia symptoms. Intervention content included parent training, sleep hygiene education, and relaxation strategies. Adaptations to the interventions for use in children with neurodevelopmental and/or medical conditions included behavioral strategies commonly used in those conditions, sleep education specific to the condition, and/or use of case examples specific to the condition. No studies reported on adverse effects. Behavioral sleep interventions had a significant effect on sleep satisfaction, bedtime resistance, and ADHD symptoms at postintervention. At follow-up, effects were maintained only for sleep satisfaction. Parent rating of child sleep duration improved at follow-up but not postintervention.

Conclusions: Despite being at high risk for comorbid sleep disruption, children with neurodevelopmental and/or medical conditions are underrepresented in the sleep intervention literature. Future research is needed with larger, more diverse samples and increased methodological rigor to address sleep disruption in these pediatric populations.

Protocol registration: Open Science Framework Preregistration doi.org/10.17605/OSF.IO/KE58C, date of registration December 9, 2023.

Objective: Poor nutrition and physical activity pose negative health risks for adolescent and young adult pediatric cancer survivors (AYACS). Our pilot randomized controlled trial (RCT) evaluated feasibility and acceptability of a telehealth intervention (ENHANCE) supporting AYACS' nutrition and physical activity.

Methods: We randomized 58 AYACS and their adult care partner, when applicable, to the ENHANCE or control condition. Inclusion required an age of 15-25 years, previous chemotherapy or radiation therapy, and no eating disorder history. We utilized a 2:1 (ENHANCE [n = 35]: control [n = 23]) double-blind block randomization protocol in blocks of 6. ENHANCE comprised 12 (60-min) sessions that included education, skill-building, and values-based healthy lifestyle decision-making. The first five sessions included motivational interviewing and the final seven sessions included problem-solving training/goal setting. We evaluated feasibility based on eligibility, enrollment, attrition, and study completion percentages. We assessed fidelity using the Session Content-Fidelity Rating Tool and the Motivational Interviewing Treatment Integrity Coding form. We assessed acceptability using the Abbreviated Acceptability Rating Profile, the Revised Helping Alliance Questionnaire, and participants' exit interviews.

Results: ENHANCE was feasible and highly acceptable; all but one participant who started the intervention completed all 12 sessions and all participants reported enjoying the intervention via objective assessment and during exit interviews. Interventionists delivered ENHANCE with high fidelity.

Conclusions: ENHANCE was highly acceptable among AYACS and care partners. The telehealth study design was feasible, suggesting benefits and feasibility of a future, larger, multisite RCT. Promising findings support our methodological decisions as important considerations to inform a larger RCT.

Objective: Adolescents and young adults with chronic diseases face unique challenges during the college years and may consume alcohol and other substances to cope with stressors. This study aimed to assess the patterns of substance use and to determine psychosocial correlates of these behaviors among college youth with type 1 diabetes (T1D).

Methods: College youth with T1D were recruited via social media and direct outreach into a web-based study. Participants answered validated questions about substance use, and they completed validated screeners of depressive and anxiety symptoms (PHQ-2 and GAD-2), illness acceptance (ICQ), interpersonal support (ISEL), and grit (Grit scale). Descriptive statistics, bivariate analyses, and multivariable regression evaluated substance use behaviors as a function of psychosocial factors while adjusting for age and sex.

Results: Alcohol (84.06%) and marijuana (41.30%) were the most common substances reported. In bivariate analyses, depressive symptoms were positively associated (p = .01) and illness acceptance was inversely associated (p = .02) with marijuana use. Higher grit scores were inversely associated with marijuana use (p < .001) and prescription drug misuse (p = .04). The significant associations between marijuana use and depressive symptoms (adjusted odds ratio [AOR] 1.31, 95% confidence interval [CI] 1.04-1.66), illness acceptance (AOR 0.96, 95% CI 0.91-0.99), and grit (AOR 0.32, 95% CI 0.17-0.60) persisted after adjustment for age and sex.

Conclusions: Substance use is prevalent among college youth with T1D. While psychosocial factors such as depressive symptoms may confer an increased risk, illness acceptance and grit may be protective-especially against marijuana use. Providers should address both positive and negative psychosocial factors to mitigate substance use in this population.

Objective: Sickle cell disease (SCD) is associated with significant morbidity and mortality. Hematopoietic stem cell transplantation (HCT) can improve health-related quality of life (HRQOL) but may be physically and emotionally challenging. Thus, the aim of this study was to understand the experience of HCT from the perspective of youth and young adults (YYAs) post-HCT for SCD and their parents.

Methods: YYAs were recruited from an urban hospital. Sociodemographic and HCT-specific information was analyzed for all enrolled. YYAs and/or their primary caregivers during HCT, participated in semi-structured interviews (e.g., pre-HCT knowledge, challenges, advice for families/health care providers). Interviews were audio-recorded, transcribed, and analyzed using content analysis.

Results: There were 19 YYAs enrolled (63.2% male; 68.4% Black or African American; 47.4% Hispanic or Latino; M days post-HCT = 1946.53 ± 1329.13; M age at HCT = 10.95 ± 6.10 years old; M current age 15.74 ± 5.78 years old). Interviews were done with six YYAs alone, five YYA-caregiver dyads, and eight caregivers alone. The caregivers were all mothers. Participants reported underestimating the emotional impact HCT would have on themselves and their family members. They experienced challenges related to isolation, academics, finances, and post-HCT medical needs. In contrast, they felt well prepared for physiological aspects of HCT. They sought HCT to improve YYAs' HRQOL and encouraged others to consider it, but to be cognizant of the potential psychosocial impact.

Conclusions: This study highlights the importance of preparing families for the psychosocial effects of HCT. Incorporating psychosocial assessment, education, and intervention throughout HCT has the potential to promote HRQOL for YYAs and their families.

Objective: Adolescents and young adults (AYAs) with cancer are a vulnerable population during a critical developmental transition that can benefit from the adoption of courageous coping. Parental support is crucial in enhancing adjustment and coping skills. The linkage between parent-adolescent communication (PAC) and the use of courageous coping (UCC), however, remains unclear. This study examined the association between PAC and UCC and possible mediators of this relationship among Korean AYAs with cancer.

Methods: In this cross-sectional, correlational study, self-report data were collected from 144 AYAs aged 11-26 years. A path analytic approach was employed using a hierarchical regression model to test for the direct relationship between PAC and UCC and the indirect effects of a proposed primary mediator (family cohesion) and two intermediary mediators (uncertainty of illness, hope) on PAC-UCC relationship.

Results: The mean age of the sample was 17 years (SD = 3.8), with 42% currently receiving cancer treatment. Greater PAC was significantly associated with increased UCC (mother figure: p = .0024, father figure: p  = .0042). Increased family cohesion significantly mediated the PAC-UCC relationship, indicated by a diminished PAC-UCC relationship after controlling for family cohesion (mother: p = .2753; father: p = .8107). Mediated mediation models indicated that increased hope stemming from decreased uncertainty was the mechanism through which family cohesion impacted the PAC-UCC relationship.

Conclusions: Findings underscore that greater PAC can facilitate UCC among Korean AYAs with cancer and provide insights for therapeutic parent-child communication. Results further demonstrate the complex mediating role of fostering family cohesion, reducing uncertainty, and fostering hope can play in the PAC-UCC relationship.

Objective: Parent-child communication is integral to pediatric asthma management. This review evaluates parent-child communication among youth with asthma and their caregivers. It aims to characterize the type of communication according to a unifying framework (Murphy, L. K., Murray, C. B., & Compas, B. E., Guest Editors: Cynthia A. Gerhardt, Cynthia A. Berg, Deborah J. Wiebe and Grayson N. Holmbeck (2017). Topical review: Integrating findings on direct observation of family communication in studies comparing pediatric chronic illness and typically developing samples. Journal of Pediatric Psychology, 42, 85-94. https://doi.org/10.1093/jpepsy/jsw051), assess sociodemographic factors associated with communication, and examine the relationship between parent-child communication and youth psychosocial and health-related outcomes.

Methods: A systematic literature search was conducted using PubMed, PsycINFO, CINAHL, Web of Science, Cochrane Library, and Embase databases (June 2021; updated May 2024). Included studies reported original, peer-reviewed research on the relationship between parent-child communication and youth psychosocial or health outcomes among pediatric patients (mean age <18 years) with asthma and their primary caregiver(s). Study quality was evaluated using the Study Quality Assessment Tools of the NHLBI.

Results: Sixty-six articles were included with data from 5,373 youth with asthma. Studies assessed both positive (warm and structured) and negative (hostile/intrusive and withdrawn) communication. Most studies used questionnaires and cross-sectional designs. Associations between sociodemographic and communication variables were largely nonsignificant. Greater positive and less negative communication was associated with better youth psychosocial and asthma outcomes overall.

Conclusion: Parent-child communication may be an important target for interventions aimed at improving youth outcomes. More research is needed to develop communication-focused interventions that aim to enhance parents' and youths' communication skills (i.e., increase their use of positive communication approaches and/or reduce their use of negative communication approaches) and evaluate their impact on youth outcomes. Future research should also use more discussion tasks and longitudinal designs.